Estimation of global insulin use for type 2 diabetes, 2018-30: a microsimulation analysis.
Pubmed ID: 30470520
Journal: The lancet. Diabetes & endocrinology
Publication Date: 01/01/2019
Affiliation: Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland.
MeSH Terms: Humans, Male, Female, Aged, Cohort Studies, Algorithms, Age Factors, Middle Aged, Prevalence, Computer Simulation, Diabetes Mellitus, Type 2, Quality-Adjusted Life Years, Insulin, Patient Care Planning, Hypoglycemic Agents, Glycated Hemoglobin A
Authors: Basu S, Sussman JB, Yudkin JS, Wild SH, Kehlenbrink S, Davies JI, Lipska KJ, Beran D
Cite As: Basu S, Yudkin JS, Kehlenbrink S, Davies JI, Wild SH, Lipska KJ, Sussman JB, Beran D. Estimation of global insulin use for type 2 diabetes, 2018-30: a microsimulation analysis. Lancet Diabetes Endocrinol 2019 Jan;7(1):25-33. Epub 2018 Nov 21.
BACKGROUND: The amount of insulin needed to effectively treat type 2 diabetes worldwide is unknown. It also remains unclear how alternative treatment algorithms would affect insulin use and disability-adjusted life-years (DALYs) averted by insulin use, given that current access to insulin (availability and affordability) in many areas is low. The aim of this study was to compare alternative projections for and consequences of insulin use worldwide under varying treatment algorithms and degrees of insulin access. METHODS: We developed a microsimulation of type 2 diabetes burden from 2018 to 2030 across 221 countries using data from the International Diabetes Federation for prevalence projections and from 14 cohort studies representing more than 60% of the global type 2 diabetes population for HbA<sub>1c</sub>, treatment, and bodyweight data. We estimated the number of people with type 2 diabetes expected to use insulin, international units (IU) required, and DALYs averted per year under alternative treatment algorithms targeting HbA<sub>1c</sub> from 6·5% to 8%, lower microvascular risk, or higher HbA<sub>1c</sub> for those aged 75 years and older. FINDINGS: The number of people with type 2 diabetes worldwide was estimated to increase from 405·6 million (95% CI 315·3 million-533·7 million) in 2018 to 510·8 million (395·9 million-674·3 million) in 2030. On this basis, insulin use is estimated to increase from 516·1 million 1000 IU vials (95% CI 409·0 million-658·6 million) per year in 2018 to 633·7 million (500·5 million-806·7 million) per year in 2030. Without improved insulin access, 7·4% (95% CI 5·8-9·4) of people with type 2 diabetes in 2030 would use insulin, increasing to 15·5% (12·0-20·3) if insulin were widely accessible and prescribed to achieve an HbA<sub>1c</sub> of 7% (53 mmol/mol) or lower. If HbA<sub>1c</sub> of 7% or lower was universally achieved, insulin would avert 331 101 DALYs per year by 2030 (95% CI 256 601-437 053). DALYs averted would increase by 14·9% with access to newer oral antihyperglycaemic drugs. DALYs averted would increase by 44·2% if an HbA<sub>1c</sub> of 8% (64 mmol/mol) were used as a target among people aged 75 years and older because of reduced hypoglycaemia. INTERPRETATION: The insulin required to treat type 2 diabetes is expected to increase by more than 20% from 2018 to 2030. More DALYs might be averted if HbA<sub>1c</sub> targets are higher for older adults. FUNDING: The Leona M and Harry B Helmsley Charitable Trust.